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Information ⬇

Synonym/Acronym

ear examination.

Rationale

To visualize and assess internal and external structures of the ear to evaluate for pain or hearing loss.

Patient Preparation

There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

  • Normal structure and appearance of the external ear, auditory canal, and tympanic membrane.
    • Pinna: Funnel-shaped cartilaginous structure; no evidence of infection, pain, dermatitis with swelling, redness, or itching
    • External Auditory Canal: S-shaped canal lined with fine hairs, sebaceous and ceruminous glands; no evidence of redness, lesions, edema, scaliness, pain, accumulation of cerumen, drainage, or presence of foreign bodies
    • Tympanic Membrane: Shallow, circular cone that is shiny and pearl gray in color, semitransparent whitish cord crossing from front to back just under the upper edge, cone of light on the right side at the 4 o’clock position; no evidence of bulging, retraction, lusterless membrane, or obliteration of the cone of light

Critical Findings and Potential Interventions ⬆ ⬇

N/A

Overview ⬆ ⬇

(Study type: Sensory, auditory; related body system: Nervous system.)

This noninvasive procedure is used to inspect the external ear, auditory canal, and tympanic membrane. Otoscopy is an essential part of any general physical examination but is also done before any other audiological studies when symptoms of ear pain or hearing loss are present.

Indications ⬆ ⬇

Interfering Factors ⬆ ⬇

Potential Medical Diagnosis: Clinical Significance of Results ⬆ ⬇

Abnormal Findings Related to

  • Cerumen accumulation
  • Ear trauma
  • Foreign bodies
  • Otitis externa
  • Otitis media
  • Tympanic membrane perforation or rupture

Nursing Implications ⬆

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Review the procedure with the patient or family.
  • Discuss how this procedure can assist in investigating suspected ear disorders. The test takes about 5 to 10 min to evaluate both ears. No discomfort will be experienced during the test.
  • Administer ordered eardrops or irrigation to prepare for cerumen removal if the auditory canal is not clear.

Procedural Information

  • Positioning for testing is in the sitting position for an adult and supine position on the caregiver’s lap for a child. An otoscope with the correct-size speculum to fit the size of the patient’s ear is selected for use. Both adults and children are assisted to position their heads appropriately for gentle speculum insertion and examination.
  • Any effusion will be cultured with a sterile swab and culture tube (see “Culture, Bacterial Various Sites [Anal/Genital, Ear, Eye, Skin, Wound, Blood, Sputum, Stool, Throat/Nasopharyngeal, Urine]” study); alternatively, a health-care provider will perform a needle aspiration from the middle ear through the tympanic membrane during the examination. Other procedures such as cerumen and foreign-body removal can also be performed.
  • Pneumatic otoscopy can be done to determine tympanic membrane flexibility. This test permits the introduction of air into the canal that reveals a reduction in movement of the membrane in otitis media and absence of movement in chronic otitis media.

Potential Nursing Actions

  • Investigate history of the patient’s known or suspected hearing loss, including type and cause; ear conditions with treatment regimens; ear surgery; and other tests and procedures to assess and diagnose auditory deficit; presence of tympanotomy tube, symptoms (especially pain, itching, drainage). Obtain a list of the patient’s current medications (especially antibiotic regimen), including over-the-counter medications and dietary supplements.
  • Explain that it may be necessary to assist in restraining a child in order to prevent damage to the ear if the child cannot remain still. Ensure that the external auditory canal is clear of impacted cerumen.

After the Study: Implementation & Evaluation Potential Nursing Actions

Treatment Considerations

  • Administer eardrops of a soothing oil, as ordered, if the canal is irritated by removal of cerumen or foreign bodies.
  • Discuss concerns related to hearing loss and therapeutic intervention options specific to diagnosis.

Clinical Judgement

  • Consider ways to discuss the implications of abnormal test results on the patient’s lifestyle.

Follow-Up Evaluation and Desired Outcomes

  • Recognize anxiety related to test results, and be supportive of impaired activity related to hearing loss.